public static MedicalEditsViewModel GetMedicalEditsServiceRequest()
{
var medicalEditsRequestParameter = new MedicalEditsViewModel
{
ActivityList = new List <MedicalEditsActivityViewModel>
{
new MedicalEditsActivityViewModel
{
Id = 1,
Quantity = "6",
Duration = "3",
ObservationList = new List <MedicalEditsObservationViewModel>(),
ActivityCode = "2040-106618-1001",
ActivityType = "5",
Unit = "GRANULAR",
}
},
DiagnosisList = new List <MedicalEditsDiagnosisViewModel>
{
new MedicalEditsDiagnosisViewModel
{
Code = "R25.0",
TypeId = 1,
Type = "Principal"
}
},
InsurancePlanId = 875,
ClaimId = "DHA-F-0045687-INS111-202002101627117-313"
};
return(medicalEditsRequestParameter);
}
public async Task <ProcessResult <MedicalEditsResult> > GetMedicalEditsAsync(MedicalEditsViewModel requestParameter)
{
var processResult = new ProcessResult <MedicalEditsResult>()
{
Succeeded = false,
StatusCode = HttpStatusCode.BadRequest
};
var prepareDataResult = await PrepareCdsParameterAsync(requestParameter).ConfigureAwait(false);
if (!prepareDataResult.Succeeded)
{
processResult.AddRangeModelError(prepareDataResult.GetModelErrors());
processResult.StatusCode = prepareDataResult.StatusCode;
processResult.Succeeded = prepareDataResult.Succeeded;
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
var result = await _medicalEditsService.GetClaimsEditsAsync(requestParameter).ConfigureAwait(false);
if (result.Success)
{
processResult.DataResult = result;
processResult.Succeeded = true;
processResult.StatusCode = HttpStatusCode.OK;
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
public async Task <IActionResult> CheckMedicalEdits([FromBody] MedicalEditsViewModel requestParameter)
{
if (ModelState.IsValid)
{
var result = await _authorizationService.GetMedicalEditsAsync(requestParameter);
return(await GetResponse(result));
}
else
{
return(BadRequest(ModelState));
}
}
private async Task <ProcessResult> PrepareCdsParameterAsync(MedicalEditsViewModel requestParameter)
{
var processResult = new ProcessResult()
{
Succeeded = false,
StatusCode = HttpStatusCode.BadRequest
};
if (requestParameter == null)
{
processResult.AddModelError("", "CdsRequest can't be null!");
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
if (requestParameter.ActivityList == null || requestParameter.ActivityList.Count == 0)
{
processResult.AddModelError("", "One activity at least is required");
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
if (requestParameter.DiagnosisList == null || requestParameter.DiagnosisList.Count == 0)
{
processResult.AddModelError("", "One diagnosis at least is required");
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
if (requestParameter.InsurancePlanId.HasValue)
{
var insurancePlan = _cacheService.CachedLists.Plans.FirstOrDefault(c => c.Id == requestParameter.InsurancePlanId);
if (insurancePlan != null)
{
requestParameter.PayerId = _cacheService.CachedLists.Payers.FirstOrDefault(c => c.Id == insurancePlan.PayerId).Code ?? null;
}
}
requestParameter.ProviderId = _httpContextAccessor.HttpContext.User.GetCurrentFacilityCode();
processResult.Succeeded = true;
processResult.StatusCode = HttpStatusCode.OK;
return(await Task.FromResult(processResult).ConfigureAwait(false));
}
/// <summary>
/// Used to get Medical Edits
/// </summary>
/// <param name="medicalEditsRequest"></param>
/// <param name="cancellationToken"></param>
/// <returns></returns>
public async Task <MedicalEditsResult> GetClaimsEditsAsync(MedicalEditsViewModel medicalEditsRequest,
CancellationToken cancellationToken = default(CancellationToken))
{
var result = new MedicalEditsResult();
try
{
//check if medicalEditsService is enabled
if (!medicalEditsSetting.IsEnabled)
{
result.Success = false;
result.Message = "Medical Edits service not enabled!";
return(result);
}
//set cancellation time for medicalEdits Service
// if cancellationToken parameter equals default CancellationToken, then set the cancel time from medialEditsSettings
if (cancellationToken == default(CancellationToken))
{
var cts = new CancellationTokenSource();
cts.CancelAfter(medicalEditsSetting.CancelTime.GetValueOrDefault());
cancellationToken = cts.Token;
}
//mapping medicalEditsViewModel to medicalEditsRequest
var medicalEditsRequestData = ToMedicalEditsRequestModel(medicalEditsRequest);
if (medicalEditsRequestData == null)
{
result.Success = false;
result.Message = "An error occurred while mapping data to MedicalEdits Request";
return(result);
}
// call GetClaimEdits api and check the returned result
var medicalEditsResult = await _medicalEditsClient.GetClaimsEditsAsync(medicalEditsRequestData, cancellationToken);
if (medicalEditsResult != null)
{
result.ResponseId = medicalEditsResult.ResponseId;
result.Message = medicalEditsResult.Message;
result.Success = medicalEditsResult.Success;
// mapping claimEdits to MedicalEditsResponse object
if (medicalEditsResult.Success && medicalEditsResult.ClaimEdits != null)
{
var medicalEditsClaimActivityList =
medicalEditsRequestData.claims.FirstOrDefault().claimSubmissionActivityList;
var ClaimEdits = medicalEditsResult.ClaimEdits.Select(x => new MedicalEditsResponse
{
EditCode = x.EditCode,
EditComment = x.EditComment,
EditType = x.EditType.Description,
ActivityId = x.ActivityId,
ActivityCode = x.GetActivityCodeValue(), // get ActivityCode value
ActivityType = _cacheService.CachedLists?.ActivityTypes?.Find(a =>
a.Code == medicalEditsClaimActivityList
.FirstOrDefault(act => act.activityCode == x.GetActivityCodeValue())
?.activityType)?.Name,
EditSource = x.EditSource,
// Set IsBlockingEdit = true ,when Drug or Generic quantity has exceeded the maximum limit that can be given for this age
IsBlockingEdit = x.EditCode == "DRU_DOS_01",
EditCommentParameters = ExtractEditCommentParameters(x)
}).ToList();
// edits returned to current cliam data
result.CurrentEdits = ClaimEdits.Where(c => c.EditSource == "CURRENT").ToList();
//edits returned claim history data
result.HistoryEdits = ClaimEdits.Where(c => c.EditSource == "HISTORY").ToList();
}
}
}
catch (MedicalEditsAPIException e)
{
result.Message = e.MedicalEditsExceptionMessage;
result.Success = false;
}
catch (OperationCanceledException e)
{
result.Message = e.Message;
result.Success = false;
}
catch (Exception e)
{
//log the exception
result.Message = "MedicalEdits request failed.";
result.Success = false;
}
return(result);
}
private MedicalEditsRequestModel ToMedicalEditsRequestModel(MedicalEditsViewModel request)
{
try
{
//set medical Service setting data
var medicalEditsRequest = new MedicalEditsRequestModel
{
password = medicalEditsSetting.Password,
username = medicalEditsSetting.UserName,
services = string.Join(',', medicalEditsSetting.Services),
isStrictCheck = medicalEditsSetting.IsStrictCheck
};
// prepare claim data
var claim = new Claim
{
claimID = request.ClaimId,
providerId = request.ProviderId,
payerId = request.PayerId
};
// set claim activities
claim.claimSubmissionActivityList = request.ActivityList?.Select(activity => new ClaimSubmissionActivity
{
activityCode = activity.ActivityCode,
activityId = activity.Id.ToString(),
activitySource = activity.ActivitySource,
activityStart = activity.StartDate.ToLocalTime().ToString("dd/MM/yyyy"),
activityType = activity.ActivityType,
clinician = activity.Clinician,
orderingClinician = activity.OrderingClinician,
duration = activity.Duration,
quantity = activity.Quantity,
unit = activity.Unit,
claimSubmissionObservationList = activity.ObservationList != null
? activity.ObservationList.Select(obs => new ClaimSubmissionObservation
{
observationCode = obs.Code,
observationValue = obs.Value,
observationValueType = obs.ValueType,
observationType = obs.Type,
}).ToList()
: null
}).ToList();
// add ActiveDrugs as history for the patient
if (request.ActiveDrugs?.Count > 0)
{
var i = 1;
claim.claimSubmissionActivityList.AddRange(request.ActiveDrugs.Select(activity => new ClaimSubmissionActivity
{
activityCode = activity.ActivityCode,
activityId = $"ActiveDrug-{i++}",
activitySource = "HISTORY",
activityStart = activity.StartDate.ToLocalTime().ToString("dd/MM/yyyy"),
activityType = activity.ActivityType,
clinician = activity.Clinician,
orderingClinician = activity.OrderingClinician,
duration = activity.Duration,
quantity = activity.Quantity,
unit = activity.Unit,
claimSubmissionObservationList = activity.ObservationList != null
? activity.ObservationList.Select(obs => new ClaimSubmissionObservation
{
observationCode = obs.Code,
observationValue = obs.Value,
observationValueType = obs.ValueType,
observationType = obs.Type,
}).ToList()
: null
}));
}
// set claim diagnosis
claim.claimSubmissionDiagnosisList = request.DiagnosisList != null
? request.DiagnosisList.Select(x => new ClaimSubmissionDiagnosis()
{
diagnosisCode = x.Code,
diagnosisSource = x.Source,
diagnosisType = x.Type
}).ToList()
: null;
// add ChronicDiseases as dignosis history for the patient
if (request.ChronicDiseases?.Count > 0)
{
var filteredChronicDiseases = request.ChronicDiseases.Where(a => !
claim.claimSubmissionDiagnosisList.Select(c => c.diagnosisCode).Contains(a.Code))?.Select(c => new ClaimSubmissionDiagnosis
{
diagnosisCode = c.Code,
diagnosisType = "Secondary", // set the type of dignosis as Secondary for ChronicDiseases
diagnosisSource = "HISTORY",
})
.ToList();
if (filteredChronicDiseases?.Count > 0)
{
claim.claimSubmissionDiagnosisList.AddRange(filteredChronicDiseases);
}
}
// set ClaimSubmissionPerson
var patient = _repository.Find <Patient>(
p => p.Id == request.PatientId && !p.IsDeleted && p.DateOfBirth > DateTimeOffset.MinValue);
if (patient != null)
{
claim.claimSubmissionPerson = new ClaimSubmissionPerson
{
dateOfBirth = patient.DateOfBirth.ToString("dd/MM/yyyy", CultureInfo.InvariantCulture),
nationalId = patient.NationalId,
patientId = patient.Code,
weight = request.Weight,
height = request.height
};
}
// set ClaimSubmissionAllergy
if (request.AllergiesList != null && request.AllergiesList.Count != 0)
{
claim.claimSubmissionAllergyList = request.AllergiesList.Select(p => new ClaimSubmissionAllergy()
{
allergyCode = p.Code,
allergyId = p.Code
}).ToList();
}
medicalEditsRequest.claims = new List <Claim>();
medicalEditsRequest.claims.Add(claim);
return(medicalEditsRequest);
}
catch
{
return(null);
}
}
public MedicalEditsServiceTest()
{
medicalEditsServiceRequest = MedicalEditsDataProvider.GetMedicalEditsServiceRequest();
}